What dermatological symptoms can be signs of diabetes?

Skin conditions can indicate diabetes, setting some patients on a path for a diabetes diagnoses. As part of the recent U.S. National Healthy Skin Month and American Diabetes Month, the American Academy of Dermatology (AAD) is highlighting a list of warning signs to help practitioners and patients understand common skin problems in diabetes—and tips to deal with them. “About a third of patients who have diabetes don’t know they have the disease. While it can affect every part of your body, problems on the skin can be the first sign that a person has diabetes,” said Dr. Robert Kirsner, professor of dermatology at the University of Miami’s Miller School of Medicine, in the AAD’s promotional material. Skin issues appear because “diabetes causes advanced glycation end products which damage tissues including skin and blood vessels,” Dr. Kirsner told the Medical Post in an email. ] Advanced glycation end-products can alter skin structure, and is involved in the pathogenesis of vascular complications. Skin problems can arise in both type 1 diabetes (T1D) and type 2 diabetes (T2D), with the latter accounting for about 90% of patients. Not only can skin issues be the important signal to trigger someone to seek medical care, cutaneous problems can also indicate poor diabetes control. While some non-diabetics may develop some of the same skin issues, diabetes should be investigated in patients presenting with these conditions, said Dr. Kirsner. A 2021 review paper by Mayo Clinic researchers on the cutaneous manifestation of diabetes in Med Clin North Am stated these manifestations have been reported in 30% to 79% of patients with diabetes mellitus (DM) and that the spectrum of cutaneous disease ranges from benign to life-threatening conditions. “Even ‘benign’ cutaneous findings are important because they may precede the disease and signal underlying DM in undiagnosed patients, or represent poorly controlled disease in those with known disease,” the authors wrote. They also noted the visible nature of skin disease can help motivate some patients to better control their diabetes. Here's what doctors should look for: Shin spots, or diabetic dermopathy (DD). The most commonly reported cutaneous manifestation of diabetes, with an incidence of 9% to 55%. These occur mostly in diabetics over 50 years of age. These spots (sometimes lines) create mild depressions in the skin, usually forming on the shins. They initially appear as red to pink ovoid papules or plaques but over a few weeks progress to small, brown, round to ovoid atrophic depressions. They are asymptomatic and don’t usually require treatment. The Mayo review noted that “DD is associated with coronary artery disease and microvascular complications (neuropathy, nephropathy and retinopathy), with the incidence of DD increasing from 21% in patients with diabetes with no microvascular complications to 81% in patients with all three complications.” Yellow, reddish or brown patches on the skin, (necrobiosis lipoidica). This affects between 0.3% to 1.6% of diabetics. Often, these begin as small raised solid bumps resembling pimples but turn into patches of swollen and hard skin. According to the review, “NL may precede diabetes, and 7% to 42% of patients with NL initially without diabetes subsequently develop impaired glucose tolerance or DM.” Darker areas of skin that feels like velvet, (acanthosis nigricans). These hyperpigmented, scaly symmetric patches and plaques usually appear on the back of the neck, armpit, groin and are associated with hyperinsulinemic states. It is often a sign of prediabetes. Skin thickening. Thickening skin occurs in 22% to 39% of patients with diabetes and is associated with diabetic neuropathy. It has been shown to decrease with improved glycemic control. There are three types: 1. subclinical and benign generalized skin thickening, 2. scleroderma-like skin changes of the hands, and 3. scleredema diabeticorum. Some cases can be treated with phototherapy or electron-beam therapy. Fluid filled blisters, (bullous diabeticorum). Affects 0.4% to 2% of patients with diabetes and classically presents as asymptomatic, tense bullae. They appear rapidly, have no inflammation and generally resolve without scarring within six weeks, but new lesions can occur. Yellowish scaly patches on and around the eyelids and are a sign of high fat levels in the blood and can indicate diabetes that is poorly controlled. Other skin changes. A variety of other skin issues can occur including dry skin (mild to severe); pruritis (affects up to 49% of patients with diabetes and is a predictor of neuropathy); diabetic foot ulcers; and nail changes and onychomycosis (yellowish fungal infection). Patients with any of these conditions should be referred to a dermatologist for care. “A team approach to care is essential with the dermatologist caring for the skin and either a primary physician or endocrinologist caring for the diabetes,” said Dr. Kirsner. The AAD emphasized that general, daily skin care is important too. Patients with diabetes should: Moisturize daily. This keeps skin flexible and prevents cracks that can lead to infection. Treat dry, cracked heels. This can prevent a serious infection, non-healing sores, and other problems. Use a gentle, non-allergenic cleanser when bathing. Gentle cleansers or one specially formulated for diabetics helps to soothe skin and prevent complications. Bathe and shower using warm (not hot) water. Hot water can strip your skin of moisture, leaving it dry, tight, and uncomfortable. Dry the skin folds carefully. If water stays in these areas, it can increase the chance of skin infection. Daily foot check. Check for redness, scales, scratches, blisters, sores, and cuts, and keep toenails short. The American Diabetes Association and Diabetes Canada also provide tips for skin care in diabetics.

What dermatological symptoms can be signs of diabetes?

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